The Philosophy of Evidence-Based Medicine

This chapter is drawn largely from a chapter in another book, the Users’ Guide to the Medical Literature (1). As the first reference to evidence-based medicine (EBM) in the published literature makes evident, EBM is about solving clinical problems (2). Historically, clinicians found solutions to problems in manuals, textbooks, or in counsel from senior colleagues. Time and experience were seen as sufficient to impart clinical wisdom. As it turned out, however, this paradigm of education and practice resulted in wide practice variations across institutions. At the same time, although important clinical research was available, few clinicians had the skillset required to critically evaluate that literature and decide on the best way to incorporate findings into clinical practice.